10120123CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6773 CLIFFORD DR I CONTRACTOR:
MCCLELLAN I PERMIT NO: 10120123
I OWNER'S NAME: BLANEY VENTURE LLC 11448 ENTRADA VERDE PL I DATE ISSUED: 03/10/201 1 1
OWNER'S PHONE: 9259449108
❑ LICENSELICENSEQ CONTRACTqR'ECLARATION
License Class Lic. # 7d S6
Contractore- Mam N1b014
te 1d l
I hereby affirm that I am licensed under the provisions o Cha ter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. c 1
0 /10/ 1 l
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
ALAMO, CA 94507 I PHONE NO: (925) 944-9108
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
r r r
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: LOT 5-CONSTRUCT 2 STORY 2,620 SQ FT SFDWL W/
ATTACHED GARAGE 456 SQ FT-(ADDR CHANGED FROM 790 S
BLANEY).
Sq. Ft Floor Area: I Valuation: $307600
I APN Number: 36911065.00 1 Occupancy Type: I
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: Date:/1/
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Add
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Profess
Signature Date
CITY OF CUPERTINO BUILDING PE
BUILDING ADDRESS: 6773 CLIFFORD DR CONTRACTOR: MCCLELLAN PERMIT NO: 10120123
DEVELOPMENT
OWNER'S NAME: BLANEY VENTURE LLC 1448 ENTRADA VERDE PL DATE ISSUED: 03/10/2011
OWNER'S PHONE: 9259449108 ALAMO, CA 94507 PHONE NO: (925) 944-9108
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lii... # "'1• l �w r
Contractor �Aee,% QeJ . Date S -
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWN\kft4UILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, l shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that l have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: LOT 5-CONSTRUCT 2 STORY 2,620 SQ FT SFDWL W/
ATTACHED GARAGE 456 SQ FT-(ADDR CHANGED FROM 790 S
BLANEY)
4/7/1 1 DEFERRED #1-TRUSS CALCS- 5/24/2011 DEFR'D # 11SS'D
Sq. Ft Floor Area: I Valuation: $307600
APN Number: 36911065.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FJZOQM LAST CALLED INSPECTION.
Issue Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove al I new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner ized agent:
Date: • "t
CONSTRUCTION LENDING AGENCY
I hereby affiQtathere is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional
CITY OF CUPERTINO BUILDING PE ON I _
BUILDING ADDRESS: 6773 CLIFFORD DR
CONTRACTOR: MCCLEQ TE
: 10120123
DEVELOPMENT
OWNER'S NAME: BLANEY VENTURE LLC
1448 ENTRADA VERDE PL
DATE ISSUED: 03/10/2011
OWNER' HONE: 9259449108
ALAMO, CA 94507
PHONE NO: (925) 944-9108
CONTRACTOR'S DECLARATION
r— F r
�LICENSED
✓ �
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
+ J O ( h '
(�ev
� 1 I �
MECH r RESIDENTIAL r COMMERCIAL r
Contractor MC L l LDate /
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: LOT 5-CONSTRUCT 2 STORY 2,620 SQ FT SFDWL W/
(commencing with Section 7000) of Division 3 of the Business & Professions
ATTACHED GARAGE 456 SQ FT-(ADDR CHANGED FROM 790 S
Code and that my license is in full force and effect.
BLANEY)
I hereby affirm under penalty of perjury one of the following two declarations:
5/26/201 1- REV# I - REVISE WINDOW OPENING CHANGE TO FRENCH DOOR -
7/27/2011 REV#I ISS'D
[ have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $307600
permit is issued.
APPLICANT CERTIFICATION
APN Number: 36911065.00
Occupancy Type:
l certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, th applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
rtino Municipal Code, Section
with all non-pointT=--Date-
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
21 ( `�
Signature`
Issued by•
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
[, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by a Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with h Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Co , c ' ns 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
Health 4au '
forthwith comply with such provisions or this permit shall be deemed revoked.
I
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
[ certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
I hereby affirm that there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
WN FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 6773 clifford dr.
DATE: 05/26/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
$400
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION
PERMIT TYPE:
WORK
revise window opening change to french door.
SCOPE
_ )bEl -I-
n
NOTE. There fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 E . 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feed Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
t.`rowtrrrc6wi 7rrx
Acoustical Fee: 0 Yes E) No
$0.00
Q
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
'rct� t l l:tac.rrrnerariftic ra Fes:
Strong Motion Fee: IBSEISMICR
$0.50
L—L—J #
$760.00
Revision
/REYSFDwL SFDWL
Bldg; Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$760.00
TOTAL FEE:
$761.50
Revised: 04/29/2011
CITY OF CUPERTINO
ICI FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 790 S BLANEY AVE LOT 5
DATE: 12/17/2010
REVIEWED BY:
EMN
APN:
BP#:
`VALUATION: 1$307,600
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Dulex
USE: p
TOT I L
FLOOR 1 RL A.
PENTAMATION 1 R3SFDW
PERMIT TYPE:
WORK
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
3,076
$2,732.44
IR3PLNCK
$2,707.96
IR3INSP
TOTALS:
3,076
$2,732.44
$2,707.96
— **4=- 19L, -
ldech. Plan Check
Plan Chcck
i I(L. P100 ChcCk
hdcch. pei'mil i e�:
Pha-, 11. Perwir 1, �
Cl<c. Per rnil Fee.
Of1wr HeJt. h'iNP.
l7rlrf'Nwl' lrrsp.
(k, I. --Ion. My.
' (tk ch_ hisp. Fc-C:
1117o ilt. fuss F"'('-
hlec'. Irt�]�, r�t�<
NOTE. These fees are based on the nreliminarv, information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E . 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,732.44
1 amps
$42.00
Electrical
IERT<200
Services
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
0 #
$21.00
Plumbing
IPRSEWER
Sewer, Sanitary
Permit Fee:
$2,707.96
Suppl. Insp. Fee-.0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
1 #
$21.00
Plumbing
IBPWSVCS
Water Service
Constr. Tax: IBCONSTAAR
1
bld s
$558.42
Acoustical Fee:
0 Yes (E) No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
PLLONGRNGR
$399.88
0
0
Travel Documentation Fee: ITRAVDOC
$42.00
Stroniz Motion Fee:
IBSEISMICR
$30.76
Select
an Administrative
Item
Bldg Stds Commission Fee: IBCBSC
$13.00
SUBTOTALS:
1 $6,484.461
$84.001
TOTAL FEE:
1
$6,568.46
Revised: 12/07/2010